Healthcare Provider Details

I. General information

NPI: 1336367101
Provider Name (Legal Business Name): SUNSHINE VILLAGE, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 SPRINGFIELD ST
THREE RIVERS MA
01080-1227
US

IV. Provider business mailing address

75 LITWIN LN
CHICOPEE MA
01020-4817
US

V. Phone/Fax

Practice location:
  • Phone: 413-289-2023
  • Fax: 413-283-3589
Mailing address:
  • Phone: 413-592-6142
  • Fax: 413-598-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SUDHAKAR VAMATHEVAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 413-592-6142